1 Year of Treatment With Canakinumab in Behçet's Disease Patients With Neurologic or Vascular Involvement

Phase 2

Completed

Conditions: Behcet Disease

Interventions: Drug: Canakinumab

Registration Number: NCT02756650

Lead Sponsor: Novartis Pharmaceuticals

Brief Summary: Primary objective of the study was to evaluate the safety and efficacy of canakinumab on the clinical and inflammatory findings of Behced Disease patients with neurologic and vascular involvement.

Detailed Description: Primary endpoint: Resolution of acute exacerbation findings related to Behçet's Disease (BD) based on achievements in any of the following items without deterioration on day 30:

For patients with parenchymal neurologic disease: Resolution of acute exacerbation of parenchymal neurologic findings based on improvements in any of the following items without deterioration on Day 30:

* Improvement of muscle strength, ataxia, or other relevant neurologic findings depending on the involved region on neurological examination (by Neuro-Behçet's Disease Score, Modified Expanded Disability Status Scale, and Modified Rankin Scores) cerebrospinal fluid

* Improvement in systemic inflammatory findings (CRP, Erythrocyte Sedimentation Rate , SAA)

* Any decrease in the size of the MRI lesion, or disappearance of contrast enhancement

* Improvement in patients' and physicians global assessment using a 10-cm visual analogue scale (VAS)

Complete response was defined as full clinical recovery to the pre-attack state, disappearance of MRI lesion(s), and normalisation of Cerebrospinal Fluid findings.

Partial response was defined as partial improvement in clinical findings, but with findings still worse than the pre-attack state, and MRI lesions, which become smaller with no or less enhancement, and a decrease in cerebrospinal fluid cell count.

Non-response was defined as no improvement in clinical findings, no change on MRI, no change in cerebrospinal fluid parameters, or worsening in those findings.

For patients with large vessel vascular disease: Resolution of acute vascular exacerbation findings related to Behçet's Disease based on achievements in any of the following items without deterioration at 1 month:

* Improvement in relevant symptoms (localised pain, abdominal pain, calf thickness, haemoptysis) by using physician and patient's global assessment with VAS

* Improvement in systemic inflammatory findings (CRP, ESR, SAA)

* Any improvement in radiological findings depending on the involved vessels (MR, CT or Doppler findings)

* Improvement in patients' and physicians global assessment using a 10-cm visual analogue scale (VAS)

Complete response was defined as clinical and laboratory improvement based on ≥50% improvements in patient's and physician's global assessments by using VAS, and ≥50% reduction in CRP values; along with stable or ≥20% reduced aneurysm size in patients with arterial involvement, and stable or ≥20% reduced calf swelling in patients with lower extremity venous thrombosis.

Partial response was defined as clinical and laboratory improvement based on observations of an improvement between 20-49% according to patient's and physician's global assessments by using VAS, 20-49% reduction in CRP values; along with stable or less than 20% reduced aneurysm size in patients with arterial involvement, and stable or less than 20% reduced calf swelling in patients with lower extremity thrombosis.

Non-response will be defined as observing no or less than 20% clinical improvement by patient's and physician's global VAS or worsening of clinical findings, no change or increase in acute phase response, increase in aneurysm size for patients with arterial involvement or progression of venous thrombosis in patients with venous involvement.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 8

Inclusion Criteria

Patients aged over 18-60 Behced Disease fulfilling the International Study Group (ISG) criteria, who have a recent exacerbation of large-vessel vascular disease and/or parenchymal neurologic disease For Neurologic Involvement

Patients experiencing an acute exacerbation of parenchymal neurologic disease involving brainstem and/or diencephalic region.
Exacerbation is defined based on the presence of both of the following:
An acute/subacute neurological syndrome including any of hemiparesis, ataxia, dysarthria,headache within the first month of onset of neurologic manifestations (without any prior high dose steroid treatment)
Compatible cranial MRI lesion involving brainstem and/or diencephalic region

For Vascular Disease :

Patients experiencing an acute exacerbation of vascular disease within the last month, involving

Large arteries (abdominal aorta, pulmonary arteries, extremity arteries)
Large veins (deep vein thrombosis of extremities, caval vein thrombosis, dural sinus thrombosis)
Compatible radiological findings (spiral CT, MR, or Doppler ultrasonography)

Exclusion Criteria

For Neurologic Involvement :

Presence of severe neurological sequelae from any previous attacks rendering the patient dependent on others physically or mentally
Any other neurological cause underlying the picture including ischemic central nervous system lesion on MRI
Any previous treatment with biological agents other than interferon-alpha or any previous treatment with cyclophosphamide
No interferon in the last 6 months, no Intra Venous Metilprednizolon in the past month

For Vascular disease and general :

Presence of severe vascular sequelae from any previous attacks rendering the patient dependent on others
Any other vascular disease complication the evaluation of exacerbation
Any previous treatment with biological agents other than interferon alpha, or any previous treatment with cyclophosphamide
No interferon alpha in the last 6 months, no IVMP in the past month
History of Squamo Cell Carcinoma OR Basal Cell Carcinoma in previous 5 years. General
Presence or history of any other inflammatory rheumatic disease
Positive Purified Protein Derivative test (according to local guidance) where an active Tuberculosis infection cannot be excluded via Quantiferon (T-Spot or radiographic imaging if needed) Pregnancy or lactation
Presence of any active or chronic infection or any major episode of infection requiring hospitalization or treatment with i.v. antibiotics within 30 days or oral antibiotics within 14 days prior to screening
History or a malignancy within the last 5 years, except for successfully excised squamous or basal cell carcinoma of the skin
Women of childbearing potential not using the contraception method(s) specified in this study, as well as women who are breastfeeding
With known sensitivity to canakinumab
Use of any other investigational agent in the last 30 days

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Canakinumab	Canakinumab	Canakinumab was administered monthly

Primary Outcome Measures

Name	Time	Method
C-reactive Protein (CRP) Values	30 days	Mean CRP (C-reactive protein) value (8 participants)
Visual Analogue Scores (VAS) for Patients' General Assessments	30 days	Participants assessed their own well-being with VAS (visual analogue scale). Score 0 means the best outcome, score 10 is the worst outcome.
Hemoptysis	30 days	The number of the participants with hemoptysis
Number of Participants With Attacks	30 days	Resolution of acute exacerbation findings related to Behçet's Disease (BD). The attacks were assessed by pyhsician global assesment. For patients with parenchymal neurologic disease: Resolution of acute exacerbation of parenchymal neurologic findings based on improvements in any of the following items without deterioration on Day 30 This was an exploratory trial that was not powered for a statistical analysis.
Modified Expanded Disability Status Scale (EDSS)	30 days	The Expanded Disability Status Scale (EDSS) is a method of quantifying disability in multiple sclerosis and monitoring changes in the level of disability over time. It is widely used in clinical trials and in the assessment of people with MS. Scale range is between 0-10 with 10 being most disability. Mean score of 3 participants who were evaluated in Neurology clinic. Other 5 participants were not evaluated for EDSS.
Visual Analogue Scores (VAS) for Stomachache	30 days	Stomacheache intensity was measured by VAS where score 0 means "no pain," and score 10 means "the worst pain''. VAS is determined separately by physician and the participants.
Physician's Global Assessment	30 days	Physician's General Assessments is VAS scale, ranging between 0-5, showing the disease status of participants. Score 0 is the worst outcome; 5 is the best outcome
Ataxia	30 days	Number of the partcipants with ataxia. 3 participants from neurology clinic were evaluated.
BDCAF (Behçet's Disease Current Activity Form)	30 days	BDCAF is an assessment that is made by physician for evaluating the disease activity in last four weeks. Score range is 0 to 12, 0 is the best outcome, 12 is the worst outcome.
Neuro-Behçet's Disability Score (NBDS)	30 days	Neuro-Behçet's disability score (NBDS) has been proposed for parenchymal-NBD patients to quantify disabilities. This comprises scores for motor and cognitive status. NBDS is the arithmetic sum of both scores and ranges from 0 to 8, with 8 being death due to NBD. 3 neurologic participants were evaluated.
Erythrocyte Sedimentation Rate (ESR)	30 days	Mean erythrocyte sedimentation rate (ESR) value (8 participants)
SAA (Serum Amyloid A)	30 days	Mean Serum Amyloid A value (8 participants)
Visual Analogue Scores (VAS) for Extremity Assessments	30 days	Extremity assessments were measured by VAS where score 0 means "no pain," and score 10 means "the worst possible pain''. The physicians and participants evaluated VAS separately.
Modified Ranking Score (mRS)	30 days	Mean Modified Rankin Scale (mRS): mRS is a scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. Scores range from 0-5 with 5 being the worst outcome. Only 3 participants from neurology clinic were evaluated with this scale.
Visual Analogue Scores (VAS) for Headache	30 days	Headache intensity was measured by VAS where score 0 means "no pain," and score 10 means "the worst pain''. Physician and participant determined the VAS score separately.
Steroid Dose Regimen	30 days	Mean steroid treatment dose (8 participants)
Physical Examination Scores Indicating Change in Muscle Strength	30 days	All 4 extremties were evaluated for muscle strength (upper right, upper left, lower right and lower left) fro each patient. Score 0 is the worst outcome whereas 5 is the best outcome for muscle strength. 3 participants from neurology clinic were assessed.
Extremity (Localized) Pain Assessment (VAS)	30 days	Localized pain in the extremities were assessed by visual analogue scale scores ranging between Scale; 0 is the best outcome; 10 is worst.